Foreign Objects in the ear

Earwax in small amounts is good for the ear. It protects the ear by gathering dead skin, hair and dirt as it moves from the inside of the ear outwards. Hence it is a natural cleanser for the ear. It also has antibacterial and antifungal properties. Earwax will move out of the ear on its own as we chew or talk. The jaw is located below the ear canal and movement of the jaw will help move the wax outwards. However, sometimes, earwax can block up the ear canal. Earwax buildup (Figure 1a-d) that fails to clear on its own is usually due to these reasons:

• Ear digging with a cotton bud or an ear pick
• Excessive earwax production
• Dry skin in the ear canal
• Small ear canal
• Frequent wearing of hearing aid or ear plugs

Many people have the habit of cleaning the ear canal with a cotton bud. This should not be done. The cotton bud is designed to clean or dry up fluid outside the ear canal (Figure 2a). It is not meant to be inserted into the ear canal (Figure 2b). The cotton bud is too big for the ear canal and insertion into the ear canal will only push the earwax and debris deeper against the ear drum. When this happen, the earwax will be jam-packed against the ear drum (Figure 3a) and the self-cleansing mechanism of the ear will fail. In some cases, patients may scratch the lining of the ear canal resulting in an ear infection, puncture the ear drum (Figure 3b) or even have the tip of the cotton bud stuck in the ear canal.

If you have an impacted ear wax, you may have decreased hearing level in that ear, ear discomfort or pain or a secondary ear infection. You should get your ear examined by a doctor and you may benefit from removal of ear wax under microscope guidance.

What is Hearing loss?

The ear can be divided into outer, middle and inner ear. The cause of hearing loss can be broadly divided into conductive or sensorineural causes (Figure 1).

Conductive hearing loss is due to a problem with sound reaching the inner ear. Most of the time, conductive hearing loss is reversible. Hearing is usually restored when the cause is successfully treated. Some of the common causes of conductive hearing loss include:

1. Impacted ear wax
2. Ear infections
3. Fluid in the middle ear (Figure 2)
4. Foreign body in the ear canal
5. Hardening or stiffening of the hearing bones

Sensorineural hearing loss is due to a problem with the inner ear structures (cochlea – which is the hearing organ or vestibular nerve – which is the hearing nerve). Unfortunately, most of the time, sensorineural hearing loss is permanent or irreversible. If the hearing loss is significant, these patients usually require a hearing aid (conventional or implantable). Some of the common cause of sensorineural hearing loss include:

1. Ageing (Presbyacousis)
2. Regular and prolonged exposure to loud noises
3. Viral infection of the inner ear structures (labyrinthitis)
4. Certain medications (ototoxic drugs)
5. Trauma

For assessment of hearing loss, your ENT Specialist will take a full clinical history, conduct a physical examination and likely perform a hearing test (audiometry). The management of hearing loss depends on the cause of hearing loss.

What are Ear infections?

Otitis externa is infection and inflammation of the ear canal (Figure 1a&b) . This occurs more often in patients who dig their ears frequently and in regular swimmers. These patients usually experience ear pain, ear discharge and sometimes hearing loss. Treatment includes cleaning of the ear (aural toilet under microscope guidance), antibiotics ear drops and keeping the ear dry till the infection resolves. Sometimes, the infection may start off from an infected hair follicle, like a pimple or boil on the skin (Figure 2a&b) .

Middle ear infections (Otitis media) are more common in children due to their immature Eustachian tube (the tube that connects the middle ear to the back of the nose) and in adults with Eustachian tube dysfunction. Eustachian tube dysfunction results in inadequate ventilation of the middle ear. Patients with middle ear infection usually experience ear blockage, ear pain and occasionally, ear discharge (if there is a hole in the ear drum). In children, they may also have fever, become restless or agitated and have significant hearing loss that may affect their speech and language development. The hearing loss is usually due to accumulation of fluid behind the ear drum (otitis media with effusion – Figure 3a). Most middle ear infections settle with a course of antibiotics and treatment of the nose if required. In patients with fluid behind the ear drum that does not resolve after a period of watchful waiting or after a course of antibiotics, a grommet tube can be placed in the ear drum to drain the fluid (Figure 3b).

What is Tinnitus?

Tinnitus is a ringing, buzzing, clicking or thumping sound in the ear. Most of the time the cause is unknown. The reason for tinnitus of unknown cause has been postulated to be misfiring of electrical signals by the hearing nerve or brain. Tinnitus is usually not due to a dangerous condition. It may be caused by hearing loss from exposure to loud noises, impacted ear wax, ear infections, certain drugs, stress and inadequate sleep. Addressing the cause of the tinnitus, tinnitus medication, tinnitus counseling and a device to mask the sound of the tinnitus may help in some patients.

Although uncommon, tinnitus associated with hearing loss only in one ear or hearing loss that is more severe in one ear, may be due to a benign tumour on the nerve close to the brain. Tinnitus of a thumping nature (similar to your heartbeat) may be a sign of a vascular tumour (growth originating from a blood vessel) close to the inner structures of the ear. Hence, patients with these symptoms should consult their ENT Specialist and have a complete ENT assessment.

What is a Tympanic membrane perforation?

The ear drum also protects the middle and inner ear from potential danger from the environment by forming a physical barrier.

The two most common cause of ear drum perforation (Figure 1) are infections and trauma. Most of the time, traumatic perforation will heal on its own in 1 to 2 months. In cases of persistent ear drum perforation, patients may consider having it patched up in a surgery called myringoplasty.

What are Ear Lumps & Bumps?

The external ear (also known as pinna) is made up of mostly skin and cartilage. Common lumps on the ear include cyst (a sac of oil), keloid (overgrowth of scar tissue) and pseudocyst (collection of water in the ear cartilage). Occasionally, a lump in the ear may be due to skin cancer (Figures 1a-f)

What is giddiness and vertigo?

Giddiness means different things to different people. It is very important for you to give an accurate description of your giddiness to the ENT Specialist so that a correct diagnosis can be made. Common descriptions for a patient who complains of giddiness include “light headed”, “drowsy”, “unstable”, “floating” or “the world or surrounding is spinning”. Vertigo is a type of giddiness where the patient feels that the world or surrounding is spinning or the patient himself/herself is spinning. Usually, patients with vertigo have a problem with the balancing system of the ear (vestibular system). However, some patients with non-vertiginous giddiness can also have problems with the vestibular system. Giddiness and vertigo have many causes and it is best that you get a full ENT assessment if you have worrisome or frequent giddiness. Amongst the common ENT causes of vertigo include:

1. Benign Paroxysmal Positional Vertigo (calcium deposits in the inner ear canal)
2. Vestibular neuronitis (inflammation or infection of the balance nerve)
3. Labyrinthitis (inflammation or infection of the balance organ of the ear)
4. Recurrent vestibulopathy (weakness of the balance organ of the ear)
5. Meniere’s disease (high pressure in the balance organ of the ear)